Oregon Medical Group

Infusion Center
1007 Harlow Road
Springfield, Oregon 97477
Phone: (541) 741-0387
Fax: (541) 242-4634

Boniva (Ibandronate Sodium) Infusion Order

Name: __________________________________________ DOB: ___________________
Diagnosis: _______________________________________ ICD-9 Code: ______________
1. Vital signs: Initial, PRN
2. Peripheral IV site with saline lock
3. Boniva (Ibandronate Sodium) 3mg IV push over 30 seconds. Okay to dilute with 0.9% normal
saline if patient requests. Administer on day 1 and then every 3 months for 12 months.
4. Pre-medicate with the following medication to help prevent hypersensitivity/allergic reactions
(please check).
__ Loratadine (Claritin) 10mg PO ___ with each infusion ___ PRN
__ Cetirizine (Zyrtec) 10mg PO ___ with each infusion ___ PRN
__ Dyphenhydramine (Benadryl) 25 mg PO or IV ___with each infusion ___ PRN
__ Acetaminophen (Tylenol) 650mg PO ___with each infusion ___ PRN
__ Solu-Medrol 40mg IV prior to infusion ___ with each infusion ___ PRN
5. For infusion/allergic reaction (itching, hives, low back pain, joint pain, bone pain)
__ Slow or stop infusion.
__ Diphenhydramine (Benadryl) 25mg in 9 mL saline slow IV push. May repeat X 1 if no premedications.
__ If reaction continues, give Solu-Medrol 40mg IV push now and repeat before every infusion.
6. Hold patient 30 minutes post-infusion to observe for signs and symptoms of reaction.

Provider signature: ___________________________________ Date: ____________

Provider printed name:________________________________